Internal Diseases and Therapy · MU Sofia

36. Acute Rheumatic feaver. Rheumocarditis

Covers acute rheumatic fever and rheumatic carditis, starting with definition, epidemiology and the streptococcal and molecular mimicry origin. It then goes through the pathology of valves, myocardium and pericardium, the major and minor clinical features, and the revised Jones criteria with a table. Differential diagnosis, treatment, primary and secondary prevention with a prophylaxis duration table, and the course toward chronic rheumatic heart disease close the note.

Inside: 9 sections · 2 labelled pictures · 3 tables · 16 flashcards · 13 min

Topic 36 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 9 sections, about 1,793 words (13 min of reading), with 16 flashcards.

In this note

  1. Definition
  2. Epidemiology
  3. Etiology
  4. Pathogenesis
  5. Clinical features
  6. Diagnosis
  7. Treatment
  8. Prevention
  9. Course, complications and prognosis

Definition

Acute rheumatic fever (ARF) is a non-suppurative, immune-mediated inflammatory disease that follows group A streptococcal pharyngitis after a latent period of about 2–4 weeks. It affects the heart, joints, brain, skin and subcutaneous tissue.

  • Rheumatic carditis (rheumocarditis) is the cardiac involvement of ARF: a pancarditis (endocardium, myocardium and pericardium). It is the only manifestation that can leave permanent damage.
  • Rheumatic heart disease (RHD): the chronic valve damage left by one or, more often, repeated attacks.
  • "It licks the joints but bites the heart": arthritis heals completely, carditis scars the valves.

Epidemiology

  • Mainly children aged 5–15 years; first attacks are rare before age 3 and uncommon in adults. Recurrences can occur in adults.
  • RHD affects about 40 million people worldwide and causes roughly 300,000 deaths a year, almost all in low- and middle-income countries (sub-Saharan Africa, South Asia, the Pacific, Indigenous Australians). It is the leading cause of acquired heart disease in young people there.
  • Rare in Europe and North America (better housing, less crowding, penicillin for sore throat), but it is still the classic cause of mitral stenosis seen in adults, often immigrants.

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